Secondary repair of a single extensor tendon or muscle in the forearm or wrist, performed after the acute phase of the original injury has passed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $535.75
Total RVUs: 16.04
Global, days: 90
Region: Wrist

Drawn from CMSAAPCFindacodeEatonhandAAOS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Specify that the repair is secondary (delayed), not primary — note the date of original injury and reason for delayed repair
Identify the exact tendon(s) or muscle(s) repaired by anatomic name (e.g., extensor digitorum communis, extensor carpi radialis brevis)
Document laterality (left or right forearm/wrist) explicitly in the operative note
Describe the surgical technique — direct suture repair, tendon graft, or tendon transfer — and any graft source if applicable
Record intraoperative findings including tendon gap, retraction, tissue quality, and any scarring or adhesions that increased complexity
State the number of tendons or muscles repaired if more than one, to support separate line-item billing

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 50 Bilateral procedure 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25272 covers secondary (delayed) repair of a single extensor tendon or muscle in the forearm or wrist. 'Secondary' is the operative word — this code applies when the repair is not performed acutely at the time of injury but instead after the initial wound has been managed, infection has cleared, or the patient presents late. Primary extensor tendon repairs use different codes; 25272 is specifically for the delayed scenario. Each additional tendon or muscle repaired in the same session is reported separately.

The 90-day global period means all routine post-op visits, splint changes, wound checks, and dressing changes through day 90 are bundled. Unrelated E/M services in that window require modifier 24. If a staged or planned secondary procedure follows within the global, use modifier 58. An unplanned return to the OR for a related complication gets modifier 78; an unrelated procedure in the same global window gets modifier 79.

Bilateral forearm extensor repairs in the same session are uncommon but not impossible — if performed, report with modifier 50 or with LT/RT on separate lines depending on payer preference. Modifier 22 is supportable when operative time or complexity significantly exceeds the typical case; attach a concise explanation letter and the operative note.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.03
Practice expense RVU	7.53
Malpractice RVU	1.48
Total RVU	16.04
Medicare national rate	$535.75
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$535.75
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI A2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 25272 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Code billed as primary repair when documentation does not clearly establish delayed or secondary timing — payers default to the lower-value primary code
Missing or ambiguous laterality in the operative note, triggering a claim edit or request for records
Modifier 22 submitted without an attached operative note or explanation letter quantifying the increased work
NCCI bundling conflict when additional forearm tendon repair codes are billed same-day without modifier 59 or XS to establish distinct procedural service
Global period violation — E/M services billed within the 90-day global without modifier 24, causing automatic denial

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What makes this a 'secondary' repair and why does it matter for coding?

Secondary means the repair was not performed immediately at the time of injury. The delay may be due to wound contamination, late presentation, or staged reconstruction. Payers and auditors will scrutinize whether documentation supports the delayed timing — if it reads like an acute repair, expect a downcoded or denied claim.

02If two extensor tendons are repaired in the same session, how do you bill?

Report 25272 for the first tendon and a second unit of 25272 (or the appropriate companion code) for each additional tendon, with modifier 51 on the lower-value service. Verify payer-specific instructions, as some commercial plans require modifier 59 or XS instead.

03Can 25272 be billed same-day as an E/M visit?

Only if the E/M is a separate, medically necessary decision-making visit unrelated to the surgical plan — add modifier 25. Within the 90-day global period post-op, any E/M must carry modifier 24 and document a reason unrelated to the repair.

04Does the 90-day global cover therapy referrals and splint fabrication?

Routine splinting and dressing changes are bundled into the global. However, separately identifiable services by a different provider (e.g., occupational therapy for hand rehabilitation) are billed independently by that provider and are not affected by the surgeon's global period.

05When is modifier 22 appropriate for 25272?

When the repair required substantially more time or effort than typical — for example, extensive scar excision, tendon gap requiring bridging, or significant adhesiolysis. Submit the operative note and a brief letter quantifying the additional work. Without documentation, payers will strip the modifier.

06Is there a site-of-service payment difference between HOPD and ASC for 25272?

Yes. HOPD and ASC facility payments differ — see the Site of Service comparison table on this page for current 2026 figures. The physician work RVU is identical regardless of setting, but the facility fee paid to the hospital or ASC varies substantially.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the secondary nature of the repair, the specific extensor tendon or muscle repaired by anatomic name, laterality, intraoperative findings (gap, retraction, scarring), and surgical technique from dictation. This prevents the most common denial for 25272 — insufficient documentation that the repair was delayed rather than primary — and gives auditors the tendon-level detail needed to defend each separately billed unit.

See how Mira captures CPT 25272 documentation